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1.
South Med J ; 112(12): 605-609, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31796968

RESUMO

OBJECTIVE: To determine the impact of implementing a musculoskeletal in-service educational intervention for emergency medicine (EM) residents on the use of point-of-care ultrasound (POCUS) to diagnose and manage shoulder dislocations in the emergency department (ED). METHODS: This study was conducted in the ED of an academic teaching hospital in Miami, Florida. It consisted of a short in-service educational intervention on how to perform and interpret POCUS, followed by an open, prospective convenience sample study in patients with clinical suspicion of shoulder dislocation. Twenty EM residents, with no prior shoulder scanning training, participated in the study. In all of the cases, the findings of the shoulder US were compared with radiographs, which were considered the reference standard. EM residents enrolled patients, and obtained and interpreted the shoulder US images. RESULTS: Seventy-eight patients were evaluated to rule out shoulder dislocation and/or fracture. Diagnosis of the dislocated shoulder was made in 55 of 78 patients, 53 of whom had anterior dislocations. Resident-driven POCUS had a sensitivity and specificity of 100% to diagnose and rule out, respectively, shoulder dislocations and relocations. There were no differences in the number of dislocations diagnosed and relocated by early and advanced EM residents. Results from a POCUS were available 22 ± 2.8 minutes sooner than x-ray for initial diagnosis and 27 ± 2.9 minutes (P < 0.0001) sooner than x-ray for assessment of reduction. CONCLUSIONS: EM resident physicians, with no previous training in shoulder US imaging, exposed to a brief in-service musculoskeletal education intervention, were able to diagnose shoulder dislocations via POCUS with high sensitivity and specificity. Shoulder US for dislocation should be a core component in EM training.


Assuntos
Medicina de Emergência/educação , Capacitação em Serviço , Internato e Residência , Sistemas Automatizados de Assistência Junto ao Leito , Luxação do Ombro/diagnóstico por imagem , Centros Médicos Acadêmicos , Serviço Hospitalar de Emergência , Feminino , Florida , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amostragem , Sensibilidade e Especificidade , Ultrassonografia
2.
Medicina (Kaunas) ; 55(9)2019 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-31450705

RESUMO

Background: Cycling is a popular source of recreation and physical activity for children and adults. With regard to the total number of sports injuries, cycling has the highest absolute number of injuries per year in the United States population. Cycling injuries can be classified into bicycle contact, traumatic, or overuse injuries. Aim of this study: The aims of this case report are to report a rare clinical complication of glenohumeral joint anterior dislocation that resulted in a patient experiencing continuous GHJ dislocations secondary to involuntary violent muscular spasms and emphasize the role of the physical therapist's differential diagnosis and clinical decision-making process in a patient following direct access referral. Case presentation: A professional 23-year-old cyclist presented to a physical therapist with spontaneous multidirectional dislocations to the right shoulder after the recurrence of trauma occurred during a recent cycling race. The dislocations do not occur at night, but occur during the day, randomly, and mostly associated with changes in the patient's psychological conditions. Directly from the clinical history, the physical therapist identified a neuro-physiological orange flag as well as an orthopedic red flag and, therefore, decided it was appropriate to refer the patient to a neurologist. It was determined by the physical therapist to be a priority to focus on the patient's neurologic status and then to evaluate the orthopedic problem. The neurological examination revealed a condition of spontaneous multidirectional dislocation associated with recurrent antero-posterior pain spasms of the shoulder joint. The neurologist prescribed medication. Following the second cycle of medication assumption, the patient was able to continue physiotherapy treatment and was referred to the orthopedic specialist to proceed with shoulder stabilization surgery. Discussion and conclusion: Currently, the diagnosis of this unusual clinical condition is still unclear. It is a shared opinion of the authors that the trauma during the past bicycle race awakened an underlying psychological problem of the patient that resulted in a clinical condition of weakness of all the structures of the shoulder, such that these spasms could result in multiple multidirectional dislocations.


Assuntos
Ciclismo/lesões , Luxação do Ombro/diagnóstico , Acidentes por Quedas , Atletas , Ciclismo/estatística & dados numéricos , Humanos , Itália , Imagem por Ressonância Magnética/métodos , Masculino , Luxação do Ombro/complicações , Luxação do Ombro/diagnóstico por imagem , Espasmo/etiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/fisiopatologia , Adulto Jovem
3.
BMC Musculoskelet Disord ; 20(1): 345, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31351453

RESUMO

BACKGROUND: Superior shoulder dislocation is a rare type of shoulder dislocation. Its occurrence is thought to be associated with rupture of the deltoid; however, few reports are available on the mechanism of onset and the treatment of a superior shoulder dislocation. Here we describe a case of dislocation in the direction of the posterior acromion, referred to as posterosuperior shoulder dislocation, caused by the traumatic rupture of deltoid posterior fibers. CASE PRESENTATION: An 83-year-old woman who fell on her right elbow in the hospital presented to our department with complaints of right shoulder pain. She had been undergoing conservative treatment for a massive rotator cuff tear and a rupture of the long head of biceps tendon 5 years previously. X-ray radiography images at the time of the trauma revealed that the right humeral head was dislocated upwards and in the direction of the posterior acromion. Magnetic resonance imaging (MRI) revealed newly ruptured deltoid posterior fibers, in addition to the massive rotator cuff tear. Closed reduction was performed and the shoulder joint was held in external rotation at 30 degrees for 6 weeks. However, re-dislocation was observed at an early stage after the removal of the orthosis and marked instability remained. CONCLUSIONS: This is the first case of posterosuperior shoulder dislocation. It suggests that rupture of the deltoid posterior fibers contributes to the onset of posterosuperior shoulder dislocation in patients with a massive rotator cuff tear. Moreover, in superior shoulder dislocation, conservative treatment may result in continuing instability which requires surgical treatment.


Assuntos
Acidentes por Quedas , Redução Fechada/instrumentação , Lesões do Manguito Rotador/complicações , Luxação do Ombro/etiologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem por Ressonância Magnética , Aparelhos Ortopédicos , Recidiva , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/cirurgia , Resultado do Tratamento
4.
Adv Gerontol ; 32(1-2): 198-202, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31228389

RESUMO

The aim of the study is to compare the frequency of the rotator cuff tears in patients younger and older than 60 years during shoulder dislocation. The study included the results of observation of 101 patients after shoulder dislocation without signs of damage of the rotator cuff before the trauma. All the patients were divided into 2 groups: older and younger than 60. All the patients after the injury underwent radiography and MRI. Pattern of injury of the shoulder joint was assessed via MRI. In patients younger than 60 years, the risk of a fracture of anterior margin of glenoid during the acute shoulder dislocation is higher by 5,18 times (95% CI 1,4-12,7) than in patients older than 60 years, due to direct mechanism and high-energy trauma in patients younger than 60 years. The risk of a fracture of the head of the humerus in the group of patients older than 60 years is 27,75 times higher (95% CI 3,57-215,135) than in the group of patients younger than 60, which is associated with age-related osteoporosis in the proximal humerus in patients of the older age group. In patients older than 60 years during the dislocation of the shoulder, the rotator cuff of the shoulder is damaged in 78,6% of cases, whereas in young patients it is 32,9%. The risk of rotator cuff damage in the older age group is 11,15 times (95% CI 4,047-30,734) higher than in young patients. Thus, all patients, especially those older than 60, should be undergo MRI to increase the accuracy of diagnosing of soft tissue injuries, which affects the choice of techniques and method of treatment.


Assuntos
Lesões do Manguito Rotador , Luxação do Ombro , Articulação do Ombro , Idoso , Humanos , Imagem por Ressonância Magnética , Manguito Rotador , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/terapia , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/terapia
5.
Chin J Traumatol ; 22(3): 177-181, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056471

RESUMO

PURPOSE: Glenoid bone defect and the defect on the posterior-superior surface of the humerus "Hill-Sachs lesion" are the commonly seen bony lesions in patients with recurrent dislocation shoulder. Computed tomography (CT) scan is considered as the best option in assessing the bony defects in the recurrent dislocation shoulder. The aim of this study was to assess the clinical and radiological co-relation in the patients with recurrent dislocation shoulder. METHODS: Forty-four patients of recurrent dislocation shoulder who were evaluated between January 2015 and December 2017 at a tertiary care center, clinically and radiologically using CT scan and meeting the inclusion criteria, were included. The correlation between the clinical history of the number of dislocations and the bone loss using CT scan was evaluated. Two sided statistical tests were performed at a significance level of α = 0.05. The analysis was conducted using IBM SPSS STATISTICS (version 22.0). RESULTS: All the patients were male with mean age of 25.95 (SD ± 4.2) years were evaluated. Twenty-four patients sustained injury in sporting activities while 20 patients sustained injury in training. There were an average of 4.68 (SD ± 3.1, range 2-15, median 3) episodes of dislocation. Forty-one patients had the glenoid bone loss while 40 had the Hill-Sachs lesions. The mean glenoid width defect was 10.80% (range 0-27%) while the mean Hill-Sachs defect was 14.27 mm (range 0-26.6 mm). The mean area of bone loss of the glenoid surface was 10.81% (range 0-22.4%). The lesions were on track in 34 patients and off track in 10 patients. CONCLUSIONS: CT scan of the shoulder joint is an effective method for assessing the amount of bone loss. The number of dislocations are correlated significantly with off-track lesions and the amount of bone loss on the glenoid and Hill-Sachs lesion. The glenoid width bone loss of more than 9.80% or Hill-Sachs defect of more than 14.80 mm are the critical defects after which the frequency of dislocations increases.


Assuntos
Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/etiologia , Articulação do Ombro/diagnóstico por imagem , Adulto , Cavidade Glenoide/diagnóstico por imagem , Cavidade Glenoide/patologia , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Masculino , Valor Preditivo dos Testes , Recidiva , Luxação do Ombro/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
6.
BMC Musculoskelet Disord ; 20(1): 173, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991989

RESUMO

BACKGROUND: As several neurologic and hardware complications have been reported with screw fixation. Suture buttons are used to serve as an alternative to screw fixation to obtain better outcome and to reduce the complication. The purpose of this study was to observe the clinical outcomes and make the radiologic assessment of a modified suture button (MSB) arthroscopic Latarjet procedure. METHODS: A total of ninty-one patients with recurrent shoulder joint dislocation who underwent MSB arthroscopic Latarjet procedure was retrospectively reviewed. Fifty cases identified from the chart review met the inclusion criteria. The clinical outcomes and position of the grafts, glenohumeral degeneration, and graft healing condition were assessed postoperatively in a follow-up with at least one and half of a year. RESULTS: All the fifty patients were satisfied with their clinical outcome. The overall complication rate was 4% in this study. The mean visual analog scale score, the affected shoulder active mobility in Ers(external rotation at the side), Era(external rotation in abduction) decreased significantly; the ASES score, Rowe score, Walch-Duplay score improved significantly. CT scans in the sagittal view showed that grafts in 88% of cases were in good position, grafts in 12% of cases were fixed too superiorly and inferiorly. In the axial view grafts in forty cases were flush with the glenoid rim, ten were considered as too lateral. The ten grafts became remodeled and were more flush with the glenoid rim in the follow-up. CONCLUSIONS: The MSB arthroscopic Latarjet procedure provides excellent outcome with few complications, and no degenerative changes were observed in the follow-up. Moreover, the graft fixed too laterally presented a phenomenon of remodeling and became flush with the glenoid rim over time.


Assuntos
Artroscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Luxação do Ombro/cirurgia , Articulação do Ombro/fisiologia , Técnicas de Sutura/efeitos adversos , Adulto , Artroscopia/efeitos adversos , Autoenxertos/transplante , Processo Coracoide/transplante , Feminino , Seguimentos , Cavidade Glenoide/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Recidiva , Estudos Retrospectivos , Luxação do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
7.
BMJ Case Rep ; 12(3)2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30904889

RESUMO

A 10-year-old boy struck a car bonnet following which his left shoulder got pinned under the wheel. No life-threatening injuries were identified. However, the patient sustained extensive abrasions to the back and the left shoulder, a closed deformity of the left clavicle and a swollen, but stable right knee. The patient was neurovascularly intact globally and all joints had a full range of motion. Plain radiographs suggested a possible greenstick fracture of the left clavicle, but also free gas within the left glenohumeral joint. Concern was raised of an unidentified open injury to the joint. CT was supportive of the finding of gas within the left glenohumeral joint, but ruled out the possible greenstick fracture as a spurious finding. There were no other injuries. The gas was within the left glenohumeral joint and was consistent with vacuum phenomenon. The injury was treated expectantly and the child made a full recovery.


Assuntos
Traumatismos do Joelho/diagnóstico por imagem , Luxação do Ombro/diagnóstico por imagem , Acidentes de Trânsito , Criança , Humanos , Traumatismos do Joelho/etiologia , Masculino , Luxação do Ombro/etiologia , Lesões do Ombro/diagnóstico por imagem , Lesões do Ombro/etiologia
8.
Bull Hosp Jt Dis (2013) ; 77(1): 21-32, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30865861

RESUMO

Anterior instability of the glenohumeral joint is a common and functionally limiting shoulder condition, particularly in young and active patients. In this population, non-operative management has been increasingly demonstrated to be associated with recurrent instability and increased long-term morbidity. Surgical treatment options include both arthroscopic and open techniques. In appropriately indicated patients, surgical treatment of first-time anterior shoulder instability is a cost-effective and successful treatment option.


Assuntos
Artroscopia , Traumatismos em Atletas/cirurgia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Adulto , Fatores Etários , Artroscopia/efeitos adversos , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Recidiva , Fatores de Risco , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/epidemiologia , Luxação do Ombro/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/lesões , Articulação do Ombro/fisiopatologia , Resultado do Tratamento , Adulto Jovem
9.
Am J Emerg Med ; 37(4): 757-761, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30797607

RESUMO

INTRODUCTION: Shoulder dislocations are a common injury causing patients to present to the emergency department. Point-of-care ultrasound (POCUS) has the potential to reduce time, radiation exposure, and healthcare costs among patients presenting with shoulder dislocations. We performed this systematic review and meta-analysis to determine the diagnostic accuracy of ultrasound compared with plain radiography in the assessment of shoulder dislocations. METHODS: PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles were assessed for all prospective and randomized control trials evaluating the accuracy of POCUS for identifying shoulder dislocation. Data were dual extracted into a predefined worksheet and quality analysis was performed with the QUADAS-2 tool. Data were summarized and a meta-analysis was performed with subgroup analyses by technique. Diagnostic accuracy of identifying associated fractures was assessed as a secondary outcome. RESULTS: Seven studies met our inclusion criteria, comprising 739 assessments with 306 dislocations. Overall, POCUS was 99.1% (95% CI 84.9% to 100%) sensitive and 99.9% (95% CI 88.9% to 100%) specific for the diagnosis of shoulder dislocation with a LR+ of 796.2 (95% CI 8.0 to 79,086.0) and a LR- of 0.01 (95% CI 0 to 0.17). There was no statistically significant difference between techniques. POCUS was also 97.9% (95% CI 10.5% to 100%) sensitive and 99.8% (95% CI 28.0% to 100%) specific for the diagnosis of associated fractures. CONCLUSIONS: POCUS is highly sensitive and specific for the identification of shoulder dislocations and reductions, as well as associated fractures. POCUS may be considered as an alternate diagnostic method for the management of shoulder dislocations.


Assuntos
Serviço Hospitalar de Emergência , Sistemas Automatizados de Assistência Junto ao Leito , Luxação do Ombro/diagnóstico por imagem , Ultrassonografia , Fraturas Ósseas/diagnóstico por imagem , Humanos , Manipulação Ortopédica
10.
Knee Surg Sports Traumatol Arthrosc ; 27(10): 3222-3229, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30725122

RESUMO

PURPOSE: Glenoid bone integrity is crucial for shoulder stability. The purpose of this study was to investigate a non-invasive method for quantifying bone loss regarding reliability and accuracy to detect glenoid bone deficiency in standard two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) measurements at different time points. It was hypothesized that the diameter of the circle used would significantly differ between raters, rendering this method inaccurate and not allowing for an exact estimation of glenoid defect size. METHODS: Fifty-two shoulder CTs from 26 patients (26 2D-CTs; 26 3D-CTs) with anterior glenoid bone defects were evaluated by 6 raters at time 0 (T0) and at least 3 weeks after (T1) to assess the glenoid bone defect using the ratio method ("best fit circle"). Inter- and intra-rater differences concerning circle dimensions (circle diameter), measured width of bone loss and calculated percentage of bone loss (length-width-ratio) were compared in 2D- versus 3D-CT scans. The intraclass coefficient (ICC) was used to determine the inter- and intra-rater agreement. RESULTS: The mean circle diameter difference in 2D-CT was 2.0 ± 1.9 mm versus 1.8 ± 1.5 mm in 3D-CT, respectively (p < 0.01). Mean width of bone loss in 2D-CT was 1.9 ± 1.7 mm compared to 1.7 ± 1.5 mm in 3D-CT, respectively (p < 0.01). The mean difference of bone loss percentage was 5.1 ± 4.8% in 2D-CT and 4.8 ± 4.5% in 3D-CT (p < 0.01). No significant differences concerning circle diameter, bone loss width and bone loss percentage were detected comparing T0 and T1. Circle diameter, bone loss width and bone loss percentage measurements in 3D-CT were significantly smaller compared to 2D-CT at T0 and T1 (p < 0.01). Agreement (ICC) was fair to good for all indicators of circle diameter (range 0.76-0.83), bone loss width (range 0.76-0.86) and percentage of bone loss (range 0.85-0.91). Overall, 3D-CT showed superior agreement compared to 2D-CT. CONCLUSION: The ratio method varies in all glenoid parameters and is not valid for consistently quantifying glenoid bone defects even in 3D computed tomography. This must be taken into consideration when determining proper surgical treatment. The degree of glenoid bone loss alone should not be used to decide for or against a bony procedure. Rather, it is more important to define a defect size as "critical" and to also take other patient-specific factors into consideration so that the best treatment option can be undertaken. Application of the "best fitting circle" is a source of error when using the ratio method; therefore, care should be taken when measuring the circle diameter. LEVEL OF EVIDENCE: III.


Assuntos
Cavidade Glenoide/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Luxação do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento Tridimensional , Masculino , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Knee Surg Sports Traumatol Arthrosc ; 27(10): 3230-3239, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30796488

RESUMO

PURPOSE: The goal of this study was to evaluate clinical and radiological outcomes after arthroscopic Latarjet stabilisation in anterior shoulder instability. METHODS: Ninety-three patients after primary arthroscopic Latarjet stabilisation were reviewed. Satisfaction, subjective shoulder value (SSV), Walch-Duplay and Rowe scores, and range of motion and stability were evaluated on clinical examination. Computed tomography (CT) was used to analyse graft position and fusion. RESULTS: Ninety patients (96.8%) were available for clinical and 85 for CT evaluation. The mean follow-up was 23.7 months (13-50, SD 7.1) and age at surgery was 26.2 years (16-44, SD 5.6). Intraoperative complications were reported in eight patients (8.9%) and recurrence in three (3.3%). Significantly, two out of three patients with recurrence had intraoperative graft complications (p = 0.0107). Forty-one patients (45.6%) reported the feeling of "subjective return to sport anxiety". External rotation with arm at the side was 59° (10-90°, SD 20) with 15° (0-70°, SD 17) of loss of rotation. These two factors correlated with results the most. Patient satisfaction was evaluated as 92% (40-100, SD 14) and SSV 90% (30-100, SD12). Revision rate after primary surgery was 10%. CT showed graft healing in 81 (95.3%) patients. A graft position between 2 and 5 o'clock was found in 70 (83.4%) patients and flush to the anterior glenoid rim in 34 (40.5%). Osteolysis of the superior part of the graft was found in 55 (64.7%) patients. CT evaluation showed no correlation with clinical results. CONCLUSION: Arthroscopic Latarjet stabilisation demonstrates satisfactory results in short-term follow-up; however, intraoperative graft-related complications are a risk factor for recurrence. "Subjective return to sport anxiety" and loss of external rotation with the arm at the side are factors worsening the results. Graft position imperfections and osteolysis of the superior part of the graft reported in CT evaluation do not influence the clinical results.


Assuntos
Complicações Intraoperatórias/etiologia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Adolescente , Adulto , Artroscopia , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Recidiva , Fatores de Risco , Luxação do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
12.
Eur J Orthop Surg Traumatol ; 29(4): 933-936, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30693386

RESUMO

Locked posterior dislocations of the shoulder with an impacted fracture of the humeral head and an articular surface defect greater than 35-40% are generally treated with a femoral head bone graft or prosthesis. We present a case in which a subtraction osteotomy with osteoclasia on the impacted zone was performed to try to make the articular surface of the humeral head congruent and continuous. With a 42-month follow-up, the clinical outcome, in terms of mobility and pain, was very good; X-rays show there was no avascular necrosis of the humeral head nor signs of articular arthrosis. The aim of this work is to present a detailed description of our procedure, which can be a therapeutic option for this type of pathology.


Assuntos
Fratura-Luxação/cirurgia , Cabeça do Úmero/cirurgia , Osteotomia/métodos , Luxação do Ombro/cirurgia , Fraturas do Ombro/cirurgia , Fratura-Luxação/diagnóstico por imagem , Humanos , Cabeça do Úmero/diagnóstico por imagem , Cabeça do Úmero/lesões , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Redução Aberta , Radiografia , Luxação do Ombro/diagnóstico por imagem , Fraturas do Ombro/diagnóstico por imagem
13.
Skeletal Radiol ; 48(7): 1131-1135, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30612160

RESUMO

Posterior dislocation of the long head of the biceps tendon uncommonly occurs with traumatic shoulder injury. The diagnosis is almost always associated with anterior shoulder dislocation which often cannot be reduced. We present a case of traumatic posterior dislocation of the long head of the biceps tendon with no reported history of shoulder dislocation, but instead a rare and specific radiographic finding. The imaging features are described, the relevant literature reviewed, and salient features discussed.


Assuntos
Ciclismo/lesões , Imagem por Ressonância Magnética/métodos , Luxação do Ombro/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem , Artroscopia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Luxação do Ombro/cirurgia , Traumatismos dos Tendões/cirurgia
14.
J Shoulder Elbow Surg ; 28(5): 869-874, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30509611

RESUMO

BACKGROUND: Anatomic skeletal features of the shoulder play important roles in anterior shoulder dislocation. However, studies on the effect of the humeral structure are few. This case-control study aimed to analyze the risk factors of anterior shoulder instability, including glenoid and humeral factors. METHODS: Anterior shoulder instability was found in 64 of 10,035 individuals who underwent magnetic resonance imaging. Propensity score matching was used to select controls matched for age, sex, height, and weight. We analyzed the glenoid and humeral structural data using conditional logistic regression analysis and identified cutoff points using receiver operating characteristic curve analysis. RESULTS: Significant differences were found between the control and dislocation groups in the depth-to-width ratio (0.119 ± 0.034 vs. 0.105 ± 0.037, P = .021), height-to-width ratio (1.51 ± 0.13 vs. 1.67 ± 0.16, P < .001), humeral head diameter-to-glenoid fossa diameter ratio (1.56 ± 0.11 vs. 1.64 ± 0.20, P < .001), and humeral containing angle (67.3° ± 5.9° vs. 60.4° ± 5.9°, P < .001). The humeral containing angle (odds ratio, 0.95; P = .024) and the glenoid height-to-width ratio (odds ratio, 7.88; P = .002), adjusted for the depth-to-width ratio and diameter ratio, were associated with anterior shoulder instability. The cutoff point for the humeral containing angle was 64° and for the height-to-width ratio was 1.60. CONCLUSIONS: This study revealed significant risk factors for shoulder instability in the Chinese Han population. The humeral containing angle and the glenoid height-to-width ratio were risk factors for anterior shoulder instability.


Assuntos
Instabilidade Articular/etiologia , Luxação do Ombro/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Cavidade Glenoide/patologia , Humanos , Cabeça do Úmero/patologia , Instabilidade Articular/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Escápula/patologia , Luxação do Ombro/diagnóstico por imagem , Adulto Jovem
15.
Skeletal Radiol ; 48(3): 467-473, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30151632

RESUMO

Luxatio erecta humeri (LEH), also known as inferior shoulder dislocation, is uncommon, comprising about 0.5% of all cases of shoulder dislocation. Synchronous bilateral LEH is exceedingly rare and, to our knowledge, there are no descriptions of axillary nerve injury on magnetic resonance imaging (MRI) following LEH. We present a case of traumatic bilateral LEH in a 59-year-old woman who fell from a fast-moving mobility scooter and sustained direct axial loading forces on the fully abducted shoulders. Both shoulders were successfully reduced using the traction-countertraction technique in the emergency department. In this article, we describe the characteristic features of LEH on plain radiography and the pattern of acute soft-tissue injuries on MRI. We emphasize the importance of reviewing the axillary neurovascular bundle, which by virtue of its location beneath the shoulder joint, is prone to injury in inferior shoulder dislocation and thus has a substantial impact on functional recovery. This important complication is unfortunately not routinely examined by radiologists, partly because of the paucity of literature highlighting its clinical significance.


Assuntos
Luxações Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Luxação do Ombro/diagnóstico por imagem , Acidentes por Quedas , Feminino , Humanos , Luxações Articulares/etiologia , Luxações Articulares/terapia , Pessoa de Meia-Idade , Luxação do Ombro/etiologia , Luxação do Ombro/terapia
16.
J Orthop Sci ; 24(2): 250-257, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30448074

RESUMO

PURPOSE: Creating a trough on the anterior glenoid rim is one of the methods used for arthroscopic Bankart repair with suture anchors. The purpose of this study was to analyze clinical and radiological outcomes of arthroscopic Bankart repair with suture anchors; to compare between the outcomes of surgical procedures with and without trough. METHODS: Clinical and radiological outcomes were evaluated for 116 patients who underwent arthroscopic Bankart repair at our institute from 2005 to 2011. The mean follow-up was 5.2 years (range, 2-8.8 years). All data were divided into trough group (n = 62) and non-trough group (n = 71). Clinical and functional outcomes were assessed pre- and postoperatively as range of motion (ROM), pain on the visual analog scale (p-VAS), function on the visual analog scale (f-VAS), and Rowe score. Radiological outcomes were also evaluated. RESULTS: The overall postoperative clinical and functional outcomes improved significantly (P < .001). A total of 8 patients (6.8%) showed recurrent instability. Radiologic findings showed mild arthritis in 27 cases (23.1%), moderate arthritis in 6 cases (5.1%), and no severe arthritis. 32 patients showed anterior apprehension after surgery, and 22 out of those 32 patients were from non-trough group. However, no significant difference between the trough and non-trough groups was found with respect to clinical and functional outcomes (P > .05). CONCLUSION: The additional procedure of creating a trough did not improve clinical outcomes in terms of frank dislocation; however, at the final follow-up, patients with the trough showed less anterior apprehension. Overall, arthroscopic Bankart repair using suture anchors had relatively good clinical outcome, with a redislocation rate of 6.8%. LEVEL OF EVIDENCE: Level III, Case series.


Assuntos
Artroplastia/métodos , Artroscopia/instrumentação , Instabilidade Articular/cirurgia , Luxação do Ombro/cirurgia , Âncoras de Sutura , Adolescente , Adulto , Artroplastia/instrumentação , Artroscopia/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Instabilidade Articular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Recidiva , Estudos Retrospectivos , Medição de Risco , Luxação do Ombro/diagnóstico por imagem , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
17.
Mil Med ; 184(3-4): e302-e305, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29901767

RESUMO

Posterior shoulder dislocation should be considered in the differential diagnosis of acute shoulder pain and immobility following trauma. Although far less common then the anterior dislocation, it is associated with high rates of comorbidity. Seventy-nine percent of posterior shoulder dislocations are missed on initial presentation, which is partially responsible for the high rate of comorbidity associated with these injuries. The mechanism of injury is varied from generalized seizure to minor trauma, which adds to the complexity of the diagnosis. There is a well-documented "vulnerable position" described as injury to the arm while it is in a flexed, adducted, and internally rotated position that is highly associated with posterior shoulder dislocation. The plain film scapular Y is the most clinically significant imaging and can be used alone to diagnose the injury, although ancillary imaging such as magnetic resonance imaging is often warranted. Once this rare condition has been diagnosed, there are a number of appropriate reduction techniques available to the health care provider. Presented here is a case of posterior shoulder dislocation that occurred while doing pushups for routine morning physical training. Also discussed are keys to recognition and treatment as well as a brief discussion of associated complications of the injury.


Assuntos
Luxação do Ombro/diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Humanos , Masculino , Condicionamento Físico Humano/efeitos adversos , Condicionamento Físico Humano/métodos , Radiografia/métodos , Luxação do Ombro/diagnóstico por imagem , Adulto Jovem
18.
Acta Med Acad ; 47(2): 165-175, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30585068

RESUMO

OBJECTIVE: To describe a new radiographic sign, "veil of obscuration", associated with posterior glenohumeral joint (shoulder) dislocations and determine its incidence and validity compared to other known classic radiographic signs. METHODS: Four-year retrospective study identified 30 acute posterior shoulder dislocation patients. Radiographs reviewed in consensus by 2 musculoskeletal radiologists for the "veil of obscuration", seen on AP shoulder radiographs and representing a comminuted fracture of the lesser tuberosity projecting over the humeral head or glenohumeral joint. Incidence of this radiographic sign of posterior glenohumeral joint dislocation in addition to other previously described classic radiographic signs, and association with other fractures, surgery, and mechanism of injury were evaluated. Continuous data was analyzed with student t-test and categorical data with Chi-Square test. RESULTS: There were 20 right and 10 left posterior shoulder dislocations. Majority of injuries resulted from vehicle crash (44%). In most cases, reverse Hill-Sachs lesion (83%) and fixed internal rotation of the humeral head (76%) were present, followed by trough line (43%) and "veil of obscuration" (40%). Trough line was seen in significantly more major trauma and vehicle crashes (78% and 46%; P=0.015), while "veil of obscuration" was seen in more seizures (86%; P=0.037) and in all surgical patients. No significant difference in presence of other classic radiographic signs in regards to surgery. CONCLUSION: The newly described radiographic sign of posterior shoulder dislocations named the "veil of obscuration" has comparable incidence as other classic radiographic signs and may be useful in the recognition and diagnosis of these injuries.


Assuntos
Luxação do Ombro/patologia , Articulação do Ombro/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Luxação do Ombro/diagnóstico , Luxação do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem
19.
Acta Orthop Belg ; 84(1): 73-77, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30457503

RESUMO

Neuroarthropathy or Charcot disease is a destructive joint pathology. Upper limb involvement is unusual and often due to syringomyelia. We reported a patient with spontaneous posterior right shoulder dislocation. Thereafter, she presented a quick joint destruction evoking a Charcot shoulder disease after excluding infectious and rheumatologic diseases. Explorations of this Charcot disease lead to the discovery and treatment of syringomyelia. A conservative management of her shoulder neuro-arthropathy has been proposed to the patient. Shoulder involvement in Charcot disease is unusual: only 5% of cases. 18 cases have been reported in English literature. Two theories try to explain Charcot disease: neuro-vascular and neuro-traumatic. There is no efficient treatment for Charcot shoulder disease but it can be prevented by surgical treatment of syringomyelia. Charcot shoulder is a rare and morbid disease for which conservative treatment is recommended because of disappointing results of arthroplasty and arthrodesis.


Assuntos
Artropatia Neurogênica/complicações , Luxação do Ombro/etiologia , Siringomielia/complicações , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Artropatia Neurogênica/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Luxação do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Siringomielia/diagnóstico por imagem
20.
Eur J Med Res ; 23(1): 50, 2018 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-30352622

RESUMO

BACKGROUND: The primary goal of this study was to analyse the anatomic configuration of the acromio-clavicular joint in a healthy population to be able to develop a classification in a second step. On the basis of the primary findings a secondary goal was to find potential clinical indications in refer to AC-joint dislocation and lateral clavicle fractures. METHODS: The upper thoracic aperture including both shoulder joints as well as both sterno-clavicular joints was retrospectively reformatted in a bone kernel in axial orientation with 0.6 mm slice thickness out of existing multiple trauma or post mortem computed tomography (CT) scans. The DICOM data was converted into the STL file format using a three dimensional (3D) reconstruction software (Smartbrush, Brainlab, Feldkirchen, Germany). The data analysis was performed using a 3D-Computer Aided Detection (CAD) Software (BioCAD, Technical University Munich, Germany). For the analysis, the angle between the cranial surface of the acromion and the tangent to its articular surface was evaluated. Accordingly, the angle between the cranial surface of the clavicle and the tangent to its articular surface was assessed. RESULTS: Overall CT-datasets of 80 healthy patients (40 males, 40 females, mean age 45 ± 8 years) were enrolled and evaluated regarding the configuration of the AC-joint. In this context, three statistically significant (p < 0.001) different configurations of the AC-joint in terms of overhanging acromion, neutral type, overhanging clavicle were identified. The "overhanging acromion" type of AC-joint configuration turned out to be the most common type (46.2%) followed by the "neutral type" (38.4%) and finally the "overhanging clavicle type" (15.4%). CONCLUSIONS: We assume that the shown differences of the AC joint congruency might play an important role in the development of different shoulder injuries resulting from the similar trauma mechanism. However, the proof of these assumptions will be the focus of future studies.


Assuntos
Articulação Acromioclavicular/diagnóstico por imagem , Clavícula/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Luxação do Ombro/diagnóstico por imagem , Articulação Acromioclavicular/anatomia & histologia , Articulação Acromioclavicular/fisiopatologia , Adulto , Cadáver , Clavícula/anatomia & histologia , Clavícula/fisiopatologia , Feminino , Fraturas Ósseas/fisiopatologia , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Luxação do Ombro/fisiopatologia , Tomografia Computadorizada por Raios X
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